DHS- - MSU School of Social Work



Ratings are distinct for each semester; they are not cumulative. Under each competency, specific practice behaviors are listed, along with specific measures for evaluating student performance.This form may be personalized with comments after each section. If any intern within a section has been rated Minimally Competent or Not Competent a specific comment must be included regarding that item in the area provided. In addition, strengths, achievements and initiatives shown by the student in the performance of his/her assignments and work contact should be noted in the comment sections or narrative summary.The Rating Scale is:Fully Competent: The student demonstrates both knowledge and ability which completely meets and/or exceeds the criteria set for the practice behavior.Mostly Competent: The student demonstrates both knowledge and ability which meets a majority of the basic expectations for the practice behavior.Moderately Competent: The student demonstrates both knowledge and ability which meets the basic expectations for the practice behavior.Minimally Competent: The student requires intensive redirection. The student demonstrates effort but has difficulty in achieving required expectations for the practice behavior.Not Competent: The student is unable to perform even minimal tasks and does not demonstrate an understanding of the theoretical base of materials.Not Applicable: Student has little or no opportunity to engage in task.Student NameStudent ID Number FORMTEXT ????? FORMTEXT ?????College/UniversityDegree Program FORMTEXT ????? FORMTEXT ?????Field Placement SiteField Instructor Name FORMTEXT ????? FORMTEXT ?????Evaluation PeriodYearTotal Hours FORMCHECKBOX Mid-Term FORMCHECKBOX Final FORMTEXT ????? FORMTEXT ?????5-Fully Competent, 4-Mostly Competent, 3-Moderately Competent, 2-Minimally Competent, 1-Not Competent, N/A-Not ApplicableCompetency12345N/ACompetency 1 – Identify as a professional social worker and conduct oneself accordinglyDisplays appropriate behavior with staff and clients – professional demeanor FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates the importance of appearance and appropriateness in dress FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates effective communication FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Utilizes professional supervision and consultation FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Maintains client confidentiality, professional roles and boundaries FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates ability to access services for clients FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Is punctual and adheres to agree upon attendance schedule FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the need to manage personal values and opinions in order to assist clients or client systems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 2 – Apply social work ethical principles to guide professional practiceRead and demonstrates an understanding of the NASW Code of Professional Values and Ethics FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the importance of considering ethical behavior in decision making by applying the NASW Code to clients and systems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Displays ability to distinguish differences among self-reflection, self-monitoring, and self-correction FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency12345N/ACompetency 3 – Apply critical thinking to inform and communication professional judgmentsDemonstrates purposeful oral and written communication in working with clients and systems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Displays the ability to organize information in an appropriate format FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Identifies and distinguishes different assessment tools FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates awareness of the importance of using different sources of information FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates familiarity and how research-based knowledge affects the client or target population FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates effective oral and writing skills when working with different populations FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 4 – Engage diversity and difference in practiceCommunicates the importance of difference in shaping life experiences FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Utilizes diversity sensitive interviewing skills FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes and describes the extent to which a particular group’s values and structures may oppress, marginalize, alienate, or enhance the privilege and power of clients and systems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates awareness of the importance of knowing personal biases and values related to different groups FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the importance of fostering a respect for diversity FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates awareness of appropriate life experiences to share with clients, groups and other individuals FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Views and utilizes staff as helpful sources of information FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 5 – Advance human rights and social and economic justiceDescribes the forms and mechanisms of oppression and discrimination related to the clients and systems of the agency FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Distinguishes the difference between oppress-sion and discrimination FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Differentiates case and cause advocacy regarding human rights and social and economic justice FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 6 – Engage in research-informed practice and practice-informed researchUses research evidence to inform practice FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes why research evidence is used FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Acknowledges how research affects the tasks performed at the agency FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the need for ongoing and existing or evidence-based research and evidence related to the field FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the importance of practice experience FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 7 – Apply knowledge of human behavior and the social environmentDemonstrates an understanding of major social work theoretical frameworks FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Articulates the connection between develop-mental stages and appropriate intervention FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates familiarity with the processes of assessment, intervention, and evaluation FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the importance of understanding others in their own environment FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates familiarity with how to gain information about others in their own environment FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 8 – Engage in policy practice to advance social and economic well-being and to deliver effective social work servicesDemonstrates an understanding of social policies FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Identifies how particular policies influence practice FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Identifies the role of practice in policy development FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Acknowledges ways to advocate for effective policy change FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 9 – Respond to contexts that shape practiceIdentify organization change that impacts clients and systems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the need to make changes to service delivery to provide effective services (i.e. different location, different population, etc.) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the role of social workers in providing leadership to support effective changes FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Demonstrates awareness of the profession’s history and commitment to improving the lives of those served or their communities FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Competency 10 – Engage with individuals, families, groups, organizations, and communitiesRecognize and distinguish between verbal and non-verbal communication as expressed by clients, colleagues, etc. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes the role he/she plays with clients/groups/organizations/communities FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Acknowledges that all participants enter the agency at different stages with different needs FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes and employs the appropriate uses of empathy FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Acknowledges why work goals and desired outcomes are created and used during field work FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes and understands methods for collecting, organizing, and interpreting client data from a variety of sources FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Recognizes and employs the different types of intervention strategies FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Identifies the special engagement needs of diverse clients across systems and the life span FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Assesses strengths and challenges of clients and systems in working toward case conceptualization FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Develop mutually agreed-upon client and system goals FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Identifies major social work interventions to help clients and systems solve problems FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Initiates culturally sensitive and developmentally appropriate actions to achieve client/system goals FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Considers prevention strategies as an integral part of the intervention process FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Assesses personal and professional strengths and challenges FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Remains open to self-reflection and feedback FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Additional Competencies FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments FORMTEXT ?????Would the DHS Field Instructor recommend the intern for a position with the Department of Human Services? FORMCHECKBOX Yes FORMCHECKBOX No (If no, why not?)Additional Feedback FORMTEXT ?????I have reviewed the above evaluation and acknowledge receipt:Student SignatureDate FORMTEXT ?????Field Instructor SignatureDate FORMTEXT ?????Field Liaison SignatureDate FORMTEXT ?????Recommended Grade (based on college/university grading scale, i.e. 4.0 scale, Pass/Fail or letter grade)Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. ................
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